You're working at your desk, trying to ignore the tingling or numbness you've had for months in your hand

and wrist. Suddenly, a sharp, piercing pain shoots through the wrist and up your arm. Just a passing cramp? More likely you have carpal tunnel syndrome, a painful progressive condition caused by compression of a key nerve in the wrist.

What is carpal tunnel syndrome?

arpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or s!uee"ed at the wrist. #he median nerve controls sensations to the palm side of the thumb and fingers $although not the little finger%, as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. #he carpal tunnel & a narrow, rigid passageway of ligament and bones at the base of the hand & houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. #he result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. 'lthough painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumati"ed.

What are the symptoms of carpal tunnel syndrome?

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. ecreased grip strength may make it difficult to form a fist, grasp small ob!ects, or perform other manual tasks. "n chronic and#or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

What are the causes of carpal tunnel syndrome?

arpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition & the carpal tunnel is simply smaller in some people than in others. (ther contributing factors include trauma or in)ury to the wrist that cause swelling, such as sprain or fracture* overactivity of the pituitary gland* hypothyroidism* rheumatoid arthritis* mechanical problems in the wrist )oint* work stress* repeated use of vibrating hand tools* fluid retention during pregnancy or menopause* or the development of a cyst or tumor in the canal. arpal tunnel syndrome is also associated with pregnancy and diseases such as diabetes, thyroid disease, or rheumatoid arthritis. +n some cases no cause can be identified.

#here is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. ,epeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. -riter's cramp & a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity & is not a symptom of carpal tunnel syndrome.

Who is at risk of developing carpal tunnel syndrome?

-omen are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. #he dominant hand is usually affected first and produces the most severe pain. .ersons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. arpal tunnel syndrome usually occurs only in adults. #he risk of developing carpal tunnel syndrome is not confined to people in a single industry or )ob, but is especially common in those performing assembly line work & manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. +n fact, carpal tunnel syndrome is three times more common among assemblers than among data&entry personnel. ' /001 study by the Mayo linic found heavy computer use $up to 2 hours a day% did not increase a person's risk of developing carpal tunnel syndrome. 3uring 1445, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. 6alf of these workers missed more than 10 days of work. #he average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about 780,000 for each in)ured worker.

How is carpal tunnel syndrome diagnosed?

9arly diagnosis and treatment are important to avoid permanent damage to the median nerve. ' physical e:amination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. #he wrist is e:amined for tenderness, swelling, warmth, and discoloration. 9ach finger should be tested for sensation, and the muscles at the base of the hand should be e:amined for strength and signs of atrophy. ,outine laboratory tests and ;&rays can reveal diabetes, arthritis, and fractures. .hysicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. +n the #inel test, the doctor taps on or presses on the median nerve in the patient's wrist. #he test is positive when tingling in the fingers or a resultant shock&like sensation occurs. #he .halen, or wrist&fle:ion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. #he presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. 3octors may also ask patients to try to make a movement that brings on symptoms.

(ften it is necessary to confirm the diagnosis by use of electrodiagnostic tests. +n a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. +n electromyography, a fine needle is inserted into a muscle* electrical activity viewed on a screen can determine the severity of damage to the median nerve. <ltrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging $M,+% can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

How is carpal tunnel syndrome treated?

#reatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. <nderlying causes such as diabetes or arthritis should be treated first. +nitial treatment generally involves resting the affected hand and wrist for at least / weeks, avoiding activities that may worsen symptoms, and immobili"ing the wrist in a splint to avoid further damage from twisting or bending. +f there is inflammation, applying cool packs can help reduce swelling. Non-surgical treatments Drugs & +n special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. =onsteroidal anti&inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. (rally administered diuretics $>water pills>% can decrease swelling. orticosteroids $such as prednisone% or the drug lidocaine can be in)ected directly into the wrist or taken by mouth $in the case of prednisone% to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. $ aution? persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. orticosterioids should not be taken without a doctor's prescription.% 'dditionally, some studies show that vitamin @A $pyrido:ine% supplements may ease the symptoms of carpal tunnel syndrome. Exercise & Stretching and strengthening e:ercises can be helpful in people whose symptoms have abated. #hese e:ercises may be supervised by a physical therapist, who is trained to use e:ercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well&being. Alternative therapies & 'cupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. 'n e:ception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome. Surgery arpal tunnel release is one of the most common surgical procedures in the <nited States. Benerally recommended if symptoms last for A months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not re!uire an overnight hospital stay. Many patients re!uire surgery on both hands. #he following are types of carpal tunnel release surgery?

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to / inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. #he procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations. Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. #he surgeon makes two incisions $about C inch each% in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament $the tissue that holds )oints together%. #his two&portal endoscopic surgery, generally performed under local anesthesia, is effective and minimi"es scarring and scar tenderness, if any. Single portal endoscopic surgery for carpal tunnel syndrome is also available and can result in less post&operative pain and a minimal scar. +t generally allows individuals to resume some normal activities in a short period of time. 'lthough symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. (ccasionally the wrist loses strength because the carpal ligament is cut. .atients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to ad)ust )ob duties or even change )obs after recovery from surgery. ,ecurrence of carpal tunnel syndrome following treatment is rare. #he ma)ority of patients recover completely.

How can carpal tunnel syndrome be prevented?

't the workplace, workers can do on&the&)ob conditioning, perform stretching e:ercises, take fre!uent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. -earing fingerless gloves can help keep hands warm and fle:ible. -orkstations, tools and tool handles, and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work. Jobs can be rotated among workers. 9mployers can develop programs in ergonomics, the process of adapting workplace conditions and )ob demands to the capabilities of workers. 6owever, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

What research is being done?

#he =ational +nstitute of =eurological 3isorders and Stroke $=+=3S%, a part of the =ational +nstitutes of 6ealth, is the federal government's leading supporter of biomedical research on neuropathy, including carpal tunnel syndrome. Scientists are studying the chronology of events that occur with carpal tunnel syndrome in order to better understand, treat, and prevent this ailment. @y determining distinct biomechanical factors related to pain, such as specific )oint angles, motions, force, and progression over time, researchers are finding new ways to limit or prevent carpal tunnel syndrome in the workplace and decrease other costly and disabling occupational illnesses.

,andomi"ed clinical trials are being designed to evaluate the effectiveness of educational interventions in reducing the incidence of carpal tunnel syndrome and upper e:tremity cumulative trauma disorders. 3ata to be collected from a =ational +nstitute for (ccupational Safety and 6ealth&sponsored study of carpal tunnel syndrome among construction workers will provide a better understanding of the specific work factors associated with the disorder, furnish pilot data for planning future pro)ects to study its natural history, and assist in developing strategies to prevent its occurrence among construction and other workers. (ther research will discern differences between the relatively new carpal compression test $in which the e:aminer applies moderate pressure with both thumbs directly on the carpal tunnel and underlying median nerve, at the transverse carpal ligament% and the pressure provocative test $in which a cuff placed at the anterior of the carpal tunnel is inflated, followed by direct pressure on the median nerve% in predicting carpal tunnel syndrome. Scientists are also investigating the use of alternative therapies, such as acupuncture, to prevent and treat this disorder. Where can I get more information? Dor more information on neurological disorders or research programs funded by the =ational +nstitute of =eurological 3isorders and Stroke, contact the +nstitute's @rain ,esources and +nformation =etwork $@,'+=% at? @,'+= ..(. @o: E501 @ethesda, M3 /05/F $500% 8E/&4F/F http?GGwww.ninds.nih.gov +nformation also is available from the following organi"ations? American Chronic Pain Association (ACPA ..(. @o: 5E0 ,ocklin, ' 4EA22&05E0 ' .'Hpacbell.net http?GGwww.theacpa.org #el? 41A&A8/&04// 500&E88&8/81 Da:? 41A&AE/&5140 !ational Institute of Arthritis and "usculoskeletal and #kin $iseases (!IA"# =ational +nstitutes of 6ealth, 366S 81 enter 3r., ,m. F 0/ MS /8E0 @ethesda, M3 /054/&/8E0 =+'MSinfoHmail.nih.gov http?GGwww.niams.nih.gov #el? 801&F4A&5140 522&//&=+'MS $//A& F/A2% %ccupational #afety & Health Administration <.S. 3epartment of Iabor /00 onstitution 'venue, =-ashington, 3 /0/10 http?GGwww.osha.gov #el? 500&8/1&(S6' $&A2F/%

Centers for $isease Control and Prevention (C$C <.S. 3epartment of 6ealth and 6uman Services 1A00 lifton ,oad, =.9. 'tlanta, B' 80888 in!uiryHcdc.gov http?GGwww.cdc.gov #el? 500&811&8F8E F0F&A84&8811GF0F&A84& 8EF8

American Academy of %rthopaedic #urgeons' American Association of %rthopaedic #urgeons A800 =orth ,iver ,oad ,osemont, +I A0015 hackettHaaos.org http?GGwww.aaos.org #el? 5F2&5/8&215A Da:? 5F2&5/8&51/E

American #ociety for #urgery of the Hand A800 =orth ,iver ,oad Suite A00 ,osemont, +l A0015&F/EA infoHassh.org http?GGwww.assh.org #el? 5F2&85F&5800 Da:? 5F2&85F&1F8E

> arpal #unnel Syndrome Dact Sheet,> =+=3S. .ublication date =ovember /00/. =+6 .ublication =o. 08&F545 @ack to arpal #unnel Syndrome +nformation .age See a list of all =+=3S 3isorders .ublicaciones en 9spaJol K SLndrome del #Mnel arpiano

.repared by? (ffice of ommunications and .ublic Iiaison =ational +nstitute of =eurological 3isorders and Stroke =ational +nstitutes of 6ealth @ethesda, M3 /054/

=+=3S health&related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the =ational +nstitute of =eurological 3isorders and Stroke or any other Dederal agency. 'dvice on the treatment or care of an individual patient should be obtained through consultation with a physician who has e:amined that patient or is familiar with that patient's medical history. 'll =+=3S&prepared information is in the public domain and may be freely copied. redit to the =+=3S or the =+6 is appreciated. Iast updated September 1A, /011

Description An in-depth report on the causes, diagnosis, treatment, and prevention of carpal tunnel syndrome. Alternative Names

,epetitive stress in)uries

Surgery:

9very year more than E00,000 people in the <S undergo surgeries for carpal tunnel syndrome. Surgery for #S is among the most common hand surgeries. +n various trials, 20 & 40N of patients who underwent surgery were free of nighttime pain afterward.
Candidates for Surgery

'lthough evidence strongly suggests that surgery is more effective than conservative approaches $at least in patients with moderate&to&severe #S%, the decision about whether to have surgery to correct #S, and when to have it, is a troubling one for patients. 9lectrodiagnostic and other tests used to confirm the presence of #S are not very useful in determining the best candidates for surgery. Severe #S may not relate at all to surgical success or the lack of it. +n general, patients with the following characteristics are less likely to respond to conservative treatment and, therefore, might benefit from surgery? K Symptoms lasting 10 months or longer K Continual numbness K Muscles in the base of the palm have begun to shrink K Symptoms occur ithin !0 seconds during a "halen#s test K Above $0 years of age Surgery does not cure all patients, and because it permanently cuts the carpal ligament, some wrist strength may be lost, but it rarely has any effect on function. ' number of e:perts believe that release surgery is performed too often. #hey recommend aggressive conservative treatment $such as splints, anti&inflammatory agents, and physical therapy% before choosing surgery. =evertheless, other e:perts argue that #S is often progressive and will worsen over time without surgery. Durthermore, evidence now shows that surgery is better than splints and conservative measures for the relief of pain. Factors that may increase the chances for successful surgery: K %aving surgery performed ithin ! years of the diagnosis of the disorder K &eing in good general health K %aving very slo nerve conduction results, but also having some muscle strength before
surgery

K Symptoms are orse at night than during the day Factors that may reduce the chances for success: K %aving very severe symptoms before surgery.

K "erforming heavy manual labor, particularly orking ith vibrating tools. Medical
evidence has found that only slightly more than half the people ho used vibrating handheld tools ere symptom-free ! years after a C'S operation.

K %aving very poor nerve conduction results before surgery. %o ever, some patients ith
severe symptoms, ho have normal neurological and physical test results, could still e(perience significant relief from C'S surgeries.

K "atients ho are on hemodialysis have good initial success, but the condition
deteriorates in about half of them after around a year and a half.

K Alcohol abuse can negatively affect the results of C'S surgery. K "oor mental health can lead to less successful surgery. K "atients ith diabetes and high blood pressure may be more likely to re)uire a second
operation. Standard Release Surgical Procedures

Open Release Surgery. #raditionally, surgery for #S entails an open surgical procedure performed in an outpatient facility. +n this procedure, the carpal ligament is cut free $released% from the median nerve. #he pressure on the median nerve is therefore relieved. #he surgery is straightforward.
*n treating carpal tunnel syndrome, surgery may be re)uired to release the compressed median nerve. 'he open release procedure involves simply cutting the transverse carpal ligament.

The ini!Open Approach. +n recent years, more surgeons have adopted a >mini> open && also called short&incision && procedure. #his surgery re!uires only a one&inch incision, but it still allows a direct view of the area $unlike endoscopy, which is viewed on a monitor%. #he mini&

open approach may allow for !uicker recovery while avoiding some of the complications of endoscopy, although few studies have investigated its benefits and risks. #he recovery time in patients receiving the mini&open approach may be shorter than with the open approach, and results are generally the same. Endoscopy. 9ndoscopy for carpal tunnel syndrome is a less invasive procedure than standard open release. K A surgeon makes one or t o 1+,-inch incisions in the rist and palm, and inserts one or
t o endoscopes -pencil-thin tubes..

K 'he surgeon then inserts a tiny camera and a knife through the lighted tubes. K /hile observing the underside of the carpal ligament on a screen, the surgeon cuts the
ligament to free the compressed median nerve.

.atients report less pain than those who had the open release procedure, and return to normal activities in about half the time. =evertheless, at this time the best evidence available does not show any significant long&term advantages of endoscopy over open release in terms of muscle, grip strength, or de:terity. #he endoscopic approach may even carry a slightly higher risk of pain afterward. #his may be due to a more limited view of the hand with endoscopy. $+n the open release procedure, the surgeon has a full view of the structures in the hand.% oncerns of irreversible nerve in)ury with endoscopic carpal tunnel release, when compared with open carpal tunnel release, e:ist because of this reduced visibility. 6owever, larger studies have shown an e:tremely low number of complications following the procedure, when performed by physicians e:perienced in the techni!ue.
Recovery after Surgery

Timing for Recovery. .atients should e:pect the following course? Dor some patients, release surgery relieves #S symptoms of numbness and tingling immediately. K "eople ho have the operation on both hands are completely incapacitated for about ,
eeks and must have someone to help them at home.

K 0eturning to strenuous ork right after surgery may cause the symptoms to return.
"atients generally stay out of ork for at least a month and often much longer, depending upon the type of surgery and the severity of the condition. 0ecovery time appears to be faster ith endoscopy than ith open release.

K *mmediately after surgery patients usually e(perience a decline in grip strength and
de(terity. Studies have reported a ide range of recovery in this area. 'he scar may remain tender for up to a year.

K "eak improvement -the best level of improvement a patient can reach. may take a long
time -up to 10 months..

"hysical Therapy. .hysical therapy following surgery has not been shown to speed up recovery or affect the final outcome of #S surgery.
Complications and Long-Term Outcome

#reatment failure and complication rates of #S surgery vary.

omplications after surgery may include the following? K 1erve damage ith tingling and numbness -usually temporary. K *nfection K Scarring K "ain K Stiffness K 2oss of some rist strength is a complication that affects 103 to a third of patients.
4ndoscopy may have better results than open release. Some patients ho have 5obs re)uiring significant strength of the hand and rist may not be able to perform them after surgery. 'hese orkers may also have problems in other parts of the upper body, including elbo s and shoulders. 'hese problems do not go a ay ith surgery and can persist. Studies indicate that 10 - 1$3 of patients change 5obs after a C'S operation.

+f pain and symptoms return, the release procedure may be repeated. ,easons for procedure failure include? K *ncomplete release of the ligament K 4(tensive scarring K 0ecurrence of the disorder due to underlying medical conditions .atients who had open release surgery appear more likely to re!uire repeat operations compared with those who have had endoscopic surgery.

Description An in-depth report on the causes, diagnosis, treatment, and prevention of carpal tunnel syndrome. Alternative Names

,epetitive stress in)uries

Symptoms:

Symptoms of carpal tunnel syndrome usually progress gradually over weeks and months and sometimes years. 'nyone with recurrent or persistent pain, numbness and tingling, or weakness of the hand should consult a doctor for a diagnosis. Symptoms often develop as follows? K *nitial symptoms include pain in the rist and palm side hand. Symptoms commonly
occur in both hands. -4ven hen only one hand is painful, the other hand often sho s signs of nerve conduction abnormalities on testing..

K 4arly on, the patient also usually reports numbness, tingling, burning, or some
combination of symptoms on the palm side of the inde(, middle, and ring fingers. -'ypically the fifth finger has no symptoms.. Such sensations may radiate to the forearm or shoulder.

K 6ver time, the hand may become numb, and patients may lose the ability to feel heat
and cold. "atients may e(perience a sense of eakness and a tendency to drop things.

K "atients may feel that their hands are s ollen even though there is no visible s elling.
'his symptom may actually prove to be an important indicator of greater C'S severity.

Symptoms may occur not only when the hand is being used but also at night when the patient is at rest. 9ven in cases where work is suspected as the cause, symptoms typically first occur outside of work. +n fact, the disorder may be distinguished from similar conditions by pain occurring at night after going to bed.

Description An in-depth report on the causes, diagnosis, treatment, and prevention of carpal tunnel syndrome. Alternative Names

,epetitive stress in)uries

Causes:

#iological $auses. arpal tunnel syndrome is considered an inflammatory disorder caused by repetitive stress, physical in)ury, or a medical condition. +t is often very difficult, however, to determine the precise cause of carpal tunnel syndrome. =o tests are available to identify a specific cause. 9:cept in patients with certain underlying diseases, the biological mechanisms leading to carpal tunnel syndrome are unknown. %or&ing $onditions versus edical "ro'lems. 'lthough some studies suggest that more than half of #S cases are associated with workplace factors, there is no strong evidence of a cause and effect relationship. +n fact, most studies now strongly suggest that carpal tunnel syndrome is primarily associated with medical or physical conditions such as diabetes, osteoarthritis, hypothyroidism, and rheumatoid arthritis. #S also tends to occur in people with certain genetic or environmental risk factors. #hese risk factors include obesity, smoking, alcohol abuse, or significant mental stress. #S sometimes has a familial risk, implying some type of genetic origin. -hen such susceptible people are sub)ected to repetitive hand or wrist work, the risk for #S can become significant. #S, then, is very likely to be due to a combination of factors that lead to nerve damage in the hand.
or!-Related "ssues and Carpal Tunnel Syndrome

(igh Force and )i'ration. 9ven though medical and physical conditions may be the initial culprits leading to #S, certain working conditions are especially related to nerve damage && if not to pure cases of #S. -ork that involves high force or vibration is particularly ha"ardous, as is repetitive hand and wrist work in cold temperatures. +n addition to #S, other disorders of the hand and wrist result from these work&related movements. #hey include the following? K %and-arm vibration syndrome -- tingling and numbing that persist even after the vibration
stops

K Cumulative trauma -repetitive stress. disorder K 6veruse syndromes K Chronic upper limb pain syndrome 'll of these problems are generally associated with repetitive and forceful use of the hands, resulting in damaged muscles and bones of the upper arms.
#edical Conditions

' number of medical conditions increase the risk for or even cause #S. #he main conditions associated with #S are diabetes, hypothyroidism, rheumatoid arthritis, osteoarthritis, obesity,

and pregnancy. Many of the underlying diseases that contribute to the development of #S are also associated with more severe forms of #S. Dia'etes. #S is a very common feature of diabetic neuropathy, one of the ma)or complications of diabetes. =europathy is decreased or distorted nerve function* it particularly affects sensation. Symptoms include numbness, tingling, weakness, and burning sensations, usually starting in the fingers and toes and moving up to the arms and legs. 'bout AN of patients with #S have diabetes. <p to 5EN of patients with type 1 diabetes develop #S. 3evelopment of #S symptoms is related to the patient's age, and the length of time they had diabetes. Autoimmune Diseases. +n autoimmune diseases, the body's immune system abnormally attacks its own tissue, causing widespread inflammation, which, in many cases, affects the carpal tunnel of the hand. Such autoimmune diseases include rheumatoid arthritis, systemic lupus erythematosus, and thyroiditis, which can lead to hypothyroidism.. Some e:perts believe that #S may actually be one of the first symptoms in a number of these diseases. Studies also suggest that #S patients with these disorders are more likely to have severe #S that re!uires surgery. Diseases that Affect uscle and #ones. 'rthritis, gout, and other medical conditions that damage the muscles, )oints, or bones in the hand may cause changes that lead to #S. Structural A'normalities. +nborn abnormalities in the bones of the hand, wrist, or forearm may contribute to #S. $hronic *idney +nsufficiency. .eople who undergo hemodialysis for chronic kidney damage often e:perience a build&up of a certain type of protein, called beta /&microglobulin, in the hand. #his build&up can result in #S. #he longer the person has been receiving hemodialysis, the greater the risk of #S. ertain drugs and procedures $particularly one procedure called hemodiafiltration% are being investigated as having the potential to reduce microglobulin build& up. +t is hoped such new methods will delay the need for carpal tunnel surgery in patients undergoing long&term hemodialysis. Other Diseases. ' number of other medical conditions may cause or increase susceptibility to #S? K 7o n syndrome K Amyloidosis -a progressive disorder of the connective tissues. K Acromegaly -a disease that leads to abnormally large hands and feet due to e(cessive
gro th hormone.

K 'umor on the median nerve -removal of the tumor often resolves the C'S in such cases. edications. 'ccording to case reports, a number of medications may increase the risk for temporary #S. #hey include certain medications that affect the immune system $such as interleukin&/%, and anticlotting drugs $such as warfarin%. #here has been conflicting evidence as to whether corticosteroids and hormone replacement therapy may increase the risk of #S. More research is needed before a cause&and&effect association can be established.
"n$uries

@one dislocations and fractures can narrow the carpal tunnel, thereby e:erting pressure on the median nerve.

%ormonal C&anges

6ormonal fluctuations in women play a role in #S. Such fluctuations may cause fluid retention and other changes that cause swelling in the body. Dluid retention is one reason that #S may develop during pregnancy.
'enetic (actors

#S is associated with a family history of the disorder. Many of these cases can be the result of physical characteristics or medical conditions associated with #S, which also run in families. 6owever, in one study, 12N of family clusters of #S were not associated with any such medical conditions, suggesting the genetic factors may be important in some people. arpal tunnel syndrome in young people most likely has a genetic component. (ther genetic factors that may contribute to this disorder include abnormalities in certain genes that regulate myelin, a fatty substance that serves as insulation for nerve fibers.

Description An in-depth report on the causes, diagnosis, treatment, and prevention of carpal tunnel syndrome. Alternative Names

,epetitive stress in)uries

Ris! (actors:

9vidence suggests that about 8N of women and /N of men will be diagnosed with carpal tunnel syndrome during their lifetime, with peak prevalence in women older than EE. Still, determining how many people actually have #S is very difficult. Many people report #S symptoms and have normal test results. (ther people have no symptoms and abnormal test results. ' large /00E study of more than 1,000 patients found that the severity of #S was mild in F/N of patients, moderate in 15N, and severe in F0N. (n average, patients were about F5 years old. More than five times as many women then men participated in the study.
Age

(lder people are at higher risk than younger adults. #S is very rare in children.
omen

Many studies indicate that women have a significantly higher risk for carpal tunnel syndrome than men do. 'ccording to the =ational +nstitutes of 6ealth, women are three times more likely than men to have carpal tunnel syndrome. #he e:planation for this greater risk is unknown, but it may be related to the smaller si"e of women's carpal tunnel. 6ormonal changes appear to play a ma)or role in #S. +n pregnant women, #S may occur in both wrists. #S that begins during pregnancy is not usually severe and persistent enough to re!uire treatment. 'lthough cases eventually go away on their own after delivery, symptoms may persist for A months or more. #S has also been shown to increase? K After delivering a baby K 7uring menopause -omen are also at a much higher risk for autoimmune disorders than men are* such disorders are significantly linked to #S.
O)esity and Lac! of (itness

@eing overweight consistently turns up as a risk factor for #S and may play a direct causal role on #S. Breater body mass appears to reduce nerve flow speed into the hand. (besity is also related to poor physical fitness, which may also increase risk. ' /00E analysis indicated that weight is strongly linked to the onset of #S in patients under the age of A8 years, but may be a less important factor as they get older.

Specific

or!ers at Ris! for CTS

-orkers who use their hands and wrists repetitively are at risk for #S, particularly if they work in cold temperatures and have factors or medical conditions that make them susceptible. $omputer ,sers and Typists. ,epetitive typing and key entry has traditionally been associated with missing work due to #S $as opposed to repetitive stress symptoms, which are unrelated to nerve impingement%. #he risk for #S in this group, however, is still much lower than with occupations involving heavy labor. 'lthough more than 10N of the computer users complain of #S symptoms, the evidence implicating computer use as a ma)or cause of #S is weak. Other )ery (igh!Ris& %or&ers. -orkers in the meat and fish packing industries and those who assemble airplanes have the highest risk for #S, according to one study. Meat packers complained of pain and loss of hand function as long ago as the 15A0s. 9ven today, the incidence of carpal tunnel syndrome in the meat, poultry, and fish packing industries may be as high as 1EN, and as high as 10N in automobile workers. usicians. Musicians are at very high risk for #S and other problems related to the muscles and nerves in the hands, upper trunk, and neck. +n one study, /0N reported #S or other nerve disorders in the hands and wrists. (ighest to -o.est /um'ers of $TS Events 'y 0o'. #he following is a list of occupations published by the @ureau of Iabor Statistics in /00A rating workers with highest to lowest total numbers of #S&related events? K 2aborers and freight, stock, and material, movers K Customer service representatives K 8irst-line supervisors+managers of office and administrative support orkers K 9anitors, maids, and housekeeping cleaners K 8ood service managers K 8irst-line supervisors+managers of retail sales orkers K Automotive service technicians and mechanics K 4(ecutive secretaries and administrative assistants K 8inancial managers K Se ing machine operators K 'ruck drivers K 6ffice clerks K Accounting and auditing clerks K /elders, cutters, solderers, and bra:ers K Sheet metal orkers K "ackers and packagers K Computer soft are engineers K *nspectors, testers, sorters, samplers, and eighers K Stock clerks and order fillers

K 'ire repairers and changers K "ackaging and filling machine operators and tenders S(<, 9S? @ureau of Iabor Statistics, <.S. 3epartment of Iabor, =ovember /00A %or&ers1 $ompensation and $TS. #he issues surrounding workers' compensation are particularly troubling in determining accurately whether labor conditions cause carpal tunnel pain. #S is a ma)or contributor to workers' compensation cases. "sychosocial Factors in the %or&place. Studies indicate that psychosocial factors in the workplace, such as intense deadlines, a poor social work environment, and low levels of )ob satisfaction, are ma)or contributors to carpal tunnel pain. Such psychosocial conditions are more likely to be important factors in contributing to #S in office workers, although they also complicate the condition in workers whose work is primarily physical. At (ome and "lay. .eople who intensively cook, knit, sew, do needlepoint, play computer games, do carpentry, or e:tensively use power tools are at increased risk for #S. Iong&distance cycling may make symptoms of carpal tunnel syndrome worse.
Ot&er P&ysical C&aracteristics

S2uare %rists. Some $but not all% studies have reported a higher risk for #S in people with s!uare wrists $the thickness and width are about the same% than in those with the more common rectangular wrists. "alm Shape. +n one study, patients with palms that were both shorter and wider than average, and who also had shorter third fingers, were more likely to have #S than those without these hand characteristics. "oor ,pper #ac& Strength. Some researchers claim that poor upper back strength makes people more susceptible to poor posture and in)uries in the upper e:tremities, including carpal tunnel syndrome.
Smo!ing and Alco&ol A)use

igarette smoking slows down blood flow, so that smokers have worse symptoms and slower recovery than nonsmokers do. +ncreased alcohol intake has been associated with #S in people with other risk factors.
Ot&er (actors

.oor nutrition, previous in)uries, and stress can increase one's risk for carpal tunnel syndrome. +n addition, high levels of so&called >bad> cholesterol $low&density lipoprotein, or I3I% have also been linked to an increased risk of #S.